Multipoint pacing for cardiac resynchronisation therapy in patients with heart failure: a systematic review and meta‐analysis

BackgroundCardiac resynchronisation therapy (CRT) is beneficial in selected patients with heart failure (HF) in normal sinus rhythm (NSR). We sought to evaluate the impact of CRT with or without atrioventricular junction (AVJ) ablation in patients with HF with concomitant atrial fibrillation (AF)Methods and resultsLiterature was searched (inception through 30 August 2017) for observational studies that reported outcomes in patients with HF with CRT and AF that reported all-cause and cardiovascular mortality. Thirty-one studies with 83, 571 patients were included. CRT did not decrease mortality compared with internal cardioverter defibrillator or medical therapy alone in patients with HF and AF with indications for CRT (OR: 0.851, 95% CI 0.616 to 1.176, p=0.328, I2=86.954). CRT-AF patients had significantly higher all-cause and cardiovascular mortality than CRT-NSR patients ([OR: 1.472, 95% CI 1.301 to 1.664, p=0.000] and [OR: 1.857, 95% CI 1.350 to 2.554, p=0.000] respectively). Change in left ventricular ejection fraction was not different between CRT patients with and without AF (p=0.705). AVJ ablation, however, improved all-cause mortality in CRT-AF patients when compared with CRT-AF patients without AVJ ablation (OR: 0.485, 95% CI 0.247 to 0.952, p=0.035). With AVJ ablation, there was no difference in all-cause mortality in CRT-AF patients compared with CRT-NSR patients (OR: 1.245, 95% CI 0.914 to 1.696, p=0.165).ConclusionThe results of our meta-analysis suggest that AF was associated with decreased CRT benefits in patients with HF. CRT, however, benefits patients with AF with AVJ ablation.

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Cardiac resynchronisation for patients with heart failure due to left ventricular systolic dysfunction - a systematic review and meta-analysis

European Journal of Heart Failure ◽

10.1016/j.ejheart.2005.11.014 ◽

2006 ◽

Vol 8 (4) ◽

pp. 433-440 ◽

Cited By ~ 71

Author(s):

N. Freemantle ◽

P. Tharmanathan ◽

M.J. Calvert ◽

W.T. Abraham ◽

J. Ghosh ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Left Ventricular Systolic Dysfunction ◽

Meta Analysis ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction ◽

Patients With Heart Failure ◽

Cardiac Resynchronisation

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Retrospective application of Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure criteria for the remote management of patients with cardiac resynchronisation therapy

Journal of Telemedicine and Telecare ◽

10.1177/1357633x16647633 ◽

2016 ◽

Vol 23 (4) ◽

pp. 470-475

Author(s):

Francesco MA Brasca ◽

Jessica Franzetti ◽

Valeria Rella ◽

Gabriella Malfatto ◽

Roberto Brambilla ◽

...

Keyword(s):

Heart Failure ◽

Remote Monitoring ◽

Area Under The Curve ◽

Cardiac Resynchronisation Therapy ◽

Failure Criteria ◽

Heart Failure Patients ◽

Patients With Heart Failure ◽

Cardiac Resynchronisation ◽

Acute Decompensation ◽

Resynchronisation Therapy

Aim The Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure (PARTNERS HF) trial elaborated a multiparametric model for prediction of acute decompensation in advanced heart failure patients, based on periodical in office data download from cardiac resynchronisation devices. In this study, we evaluated the ability of the PARTNERS HF criteria to detect initial decompensation in a population of moderate heart failure patients under remote monitoring. Methods We retrospectively applied the PARTNERS HF criteria to 1860 transmissions from 104 patients (median follow up 21 months; range 1–67 months), who were enrolled in our programme of telemedicine after cardiac resynchronisation therapy. We tested the ability of a score based on these criteria to predict any acute clinical decompensation occurring in the 15 days following a transmission. Results In 441 cases, acute heart failure was diagnosed after the index transmission. The area under the curve (AUC) of the score for the diagnosis of acute decompensation was 0.752 (confidence interval (CI) 95% 0.728–0.777). The best score cut-off was consistent with the results of PARTNERS HF: with a score ≥2, sensitivity was 75% and specificity 68%. The odds ratio for events was 6.24 (CI 95% 4.90–7.95; p < 0.001). Conclusions When retrospectively applied to remote monitoring transmissions and arranged in a score, PARTNERS HF criteria could identify HF patients who subsequently developed acute decompensation. These results warrant prospective studies applying PARTNERS HF criteria to remote monitoring.

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